Abdominal adiposity change in white and black midlife women: The study of women's health across the nation

OBJECTIVE

The principal objective of this investigation was to compare the naturalistic intra-abdominal adipose tissue (IAAT) change among black and white women during midlife.

METHODS

A cohort of 222 (56%) white and 171 (44%) black midlife women were investigated in the Fat Patterning Study at the Chicago site of the Study of Women's Health Across the Nation. The subjects' total body fat was assessed by dual-energy X-ray absorptiometry and IAAT by a planimetric computed tomography (at the level of L4 -L5 ) annually over up to 4 years.

RESULTS

The total body fat at initial evaluation was higher in black women (45.1% ± 8.2%) when compared with white women (41.3% ± 8.7%, P < 0.001) and did not significantly change over the longitudinal follow-up. No significant racial differences were found in the mean annualized gain of IAAT (4.4% ± 0.5%) in models adjusted for total body fat, initial IAAT, age, race, time and race interaction, physical activity, depressive symptoms, menopausal status, and menopausal hormone therapy.

CONCLUSIONS

During a naturalistic observation, black and white midlife women had similar abdominal fat gain adjusted for differences in baseline adiposity. These data inform future research aimed to prevent IAAT gain during the critical midlife period of rising cardiovascular risk.

Sleep disturbance during the menopausal transition in a multi-ethnic community sample of women

STUDY OBJECTIVES

Examine age-adjusted odds and racial/ethnic differences in self-reported difficulties falling and staying asleep and early morning awakening in midlife women to determine whether difficulty sleeping increased with progression through the menopausal transition.

DESIGN

Longitudinal analysis.

SETTING

Community-based.

PARTICIPANTS

3,045 Caucasian, African American, Chinese, Japanese, and Hispanic women, aged 42-52 years and pre- or early peri-menopausal at baseline, participating in the Study of Women's Health Across the Nation (SWAN).

INTERVENTIONS

None.

MEASUREMENTS AND RESULTS

Self-reported number of nights of difficulty falling asleep, staying asleep, and early morning awakening during the previous 2 weeks were obtained at baseline and 7 annual assessments. Random effects logistic regression was used to model associations between each of the 3 sleep measures and the menopausal transition, defined by bleeding patterns, vasomotor symptoms (VMS), and estradiol (E2) and follicle stimulating hormone (FSH) serum levels. Adjusted odds ratios (ORs) for difficulty falling asleep and staying asleep increased through the menopausal transition, but decreased for early morning awakening from late perimenopause to postmenopause. Naturally and surgically postmenopausal women using hormones, compared with those who were not, generally had lower ORs for disturbed sleep. More frequent VMS were associated with higher ORs of each sleep difficulty. Decreasing E2 levels were associated with higher ORs of trouble falling and staying asleep, and increasing FSH levels were associated with higher ORs of trouble staying asleep. Racial/ethnic differences were found for staying asleep and early morning awakening.

CONCLUSIONS

Progression through the menopausal transition as indicated by 3 menopausal characteristics--symptoms, bleeding-defined stages, and endogenous hormone levels--is associated with self-reported sleep disturbances.

'Sex for life'? Men's counter-stories on 'erectile dysfunction', male sexuality and ageing

Discourse on male sexuality in mid-to-later life has exploded in recent years (Gullette 1998). Attention to this topic has been spurred by the advent of (highly profitable) sexuopharmaceutical 'solutions' to erectile changes affecting older men. 'Success' stories abound in the media and in medical literature related to the restoration of faulty erections and ailing sex lives through drugs such as Viagra (sildenafil citrate), Uprima (apomorphine) and Cialis (tadalafil). In this paper we explore some of the ways in which notions about ageing and male sexuality are changing in popular cultural and medical texts in response to the advent of Viagra and the increasing authority of biomedicine in this area. We also demonstrate how the recent biomedical endorsement of 'sex for life' (the imperative to maintain an active youthful masculine [hetero]sexuality - defined in terms of male orgasm through penetrative sex) may be challenged by the very accounts of older men who are, or have been, affected by erectile difficulties and have used drugs like Viagra themselves. We present the perspectives of mid-to-late life heterosexual men in New Zealand whose stories question the contemporary biomedical privileging of erections and intercourse 'at any cost and at any age'. We argue that the current push to identify and treat so-called erectile dysfunction (and restore erections and penetrative sex to relationships) neglects some men's own experiences of alternative modes of relating sexually that they identify as 'normal', 'healthy', 'enjoyable' and 'satisfying' for them and their partners; and undermines their understanding of such changes as positive outcomes of ageing, experience and maturity.

Developing an Instrument to Measure Climacteric Symptoms among Korean and Japanese Women

PURPOSE

The purpose of this study was to construct a measurement instrument for climacteric symptoms among Korean and Japanese women.

METHODS

From Dec. 1st of 2003 to March 30th of 2004, in-depth interviews were made with 26 women (15 in Jinju, Korea and 11 in Nagasaki, Japan) aged from 45 to 59 years who had not taken hormone replacement therapy to relieve the climacteric symptoms. A draft questionnaire with 45 items was constructed on the basis of the interview data and literature review. Three obstetricians, three PhDs in nursing science, and a chief nurse who was exclusively in charge of the climacteric management, examined the draft questionnaire to evaluate content validity. After deletions 39 items remained for a preliminary questionnaire. A survey was conducted by using a convenient sampling method in Jinju of Korea and Nagasaki of Japan during the period from April 1st, 2004 to July 10th, 2005.

RESULTS

Factor analysis identified 4 factors, which were "mental and psychological symptoms", "physical symptoms", "loss of autonomic nervous system symptoms", "sexual symptoms". These four factors explained 46.9% of total variance.

CONCLUSIONS

The results demonstrated that climacteric symptom scale was multidimensional, and the reliability and validity of the scale was supported.

Relation of Urinary Incontinence, Menopausal Symptoms, and Life Satisfaction in Middle-Age Korean Women

Associations of urinary incontinence, menopausal symptoms and life satisfaction of 235 middle-age Korean women (40 to 59 years) were investigated, based on responses to a self-report questionnaire. Urinary incontinence was positively correlated with menopausal symptoms ( r = .24) and negatively correlated with life satisfaction ( r = –.11). Life satisfaction was negatively correlated with menopausal symptoms ( r = –.28). All rs indicate weak associations and account for small common variables. Even so, results suggest effective treatment of urinary incontinence and menopausal symptoms could enhance life satisfaction through promoting healthy behavior and emotional health in such middle-age women.

An exploration of the mother-child relationship between climacteric mothers and their adolescent daughters

Climacteric women face multidimensional changes including physical, psychological, social changes and changes in family structure. However, there have been few studies about the related family structure changes for climacteric women. The purpose of this study was to explore the parent-child relations between climacteric women and their adolescent daughters. Data was collected by interview, using Parent-Child Relations Scale questionnaires with purposive sampling of 70 female (mothers) who were in perimenopausal or post-menopause and 70 current nursing students (daughters) who were studying at a junior nursing college. A total of 140 subjects were recruited from residents of the Chiayi-Tainan area of Taiwan. SPSS for Windows 10.0 was used. The results indicated that the most of the women had positive parent-child relationships, and demonstrated that the women' s sense of attachment was quite strong. Significant differentiation was found for the dimensions "sense of attachment", "without sense of autonomy", "sense of indebtedness", "sense of respect" and "instrumental valence" between perimenopausal mothers and their daughters (p < .01). In addition, the teenage girls ' perception of the parent-child relationship was higher than the mothers' (p < .01). It is therefore suggested that nursing care should go beyond the scope of disease treatment and include related socio-psychological priorities, such as the parent-child relationship, in evaluation and nursing procedures, and encourage middle-aged women to include their parent-child relationships in their life planning.

Globalization and the experiences of aging

Globalization is a product of urbanization and economic intensification which has escalated since the 1970s. Globalized markets have created many of the features of modern life including consumerism, increased cultural homogeneity, increased social polarization, erosion of the sovereignty of nation states, and delocalization of daily life. The consequences of globalization for older people are primarily disadvantageous. Most notably is the restructuring of the redistributive economy. The globalization of labor results in lower wages and marked social stratification. Also family life is altered with fewer relatives who must balance work and family obligations.

Relationship between menopausal symptoms and menopausal status in Australian and Japanese women: preliminary analysis

The main aim of the present study was to explore the midlife experience for women living in Australia and Japan. The specific objectives of the study included: (i) comparing menopausal symptoms between the two groups; and (ii) comparing the factor structure of symptoms and exploring their relationship to menopausal status. Postal questionnaires were distributed to two structured, random population based samples of midlife women aged 45-60 years; consisting of 712 women living in Australia and 1502 women living in Japan. Analysis showed significant differences in menopausal symptoms related to psychological symptoms (P < 0.001), including anxiety (P < 0.001) and depression (P < 0.001), somatic symptoms (P < 0.001), and vasomotor symptoms (P < 0.01). The analysis, which excluded hormone replacement therapy (HRT) users, found that there were significant differences seen across menopausal status in the following symptoms: difficulty in sleeping (P < 0.01), difficulty in concentrating (P < 0.01), feeling dizzy or faint (P < 0.001), loss of interest in most things (P < 0.01) and loss of feeling in hands or feet (P < 0.001). In the postmenopausal stage specifically, significant differences were seen in the areas of feeling tense or nervous (P < 0.01), feeling unhappy or depressed (P < 0.01), parts of body feeling numb or tingling (P < 0.05), headaches (P < 0.01), and sweating at night (P < 0.05). Our analysis revealed that the experience of menopause for women is different between Australian and Japanese women.

Racial/ethnic differences in the prevalence of depressive symptoms among middle-aged women: The Study of Women's Health Across the Nation (SWAN)

OBJECTIVES

We examined racial/ethnic differences in significant depressive symptoms among middle-aged women before and after adjustment for socioeconomic, health-related, and psychosocial characteristics.

METHODS

Racial/ethnic differences in unadjusted and adjusted prevalence of significant depressive symptoms (score >/= 16 on the Center for Epidemiologic Studies Depression [CES-D] Scale) were assessed with univariate and multiple logistic regressions.

RESULTS

Twenty-four percent of the sample had a CES-D score of 16 or higher. Unadjusted prevalence varied by race/ethnicity (P <.0001). After adjustment for covariates, racial/ethnic differences overall were no longer significant.

CONCLUSIONS

Hispanic and African American women had the highest odds, and Chinese and Japanese women had the lowest odds, for a CES-D score of 16 or higher. This variation is in part because of health-related and psychosocial factors that are linked to socioeconomic status.

Midlife myths and realities: women reflect on their experiences

This was one in a series of studies whose goal was creation of a rich, deep description of women's midlife psychological development. All studies in the series used qualitative approaches of unstructured focus groups followed by grounded-theory data analysis. The participants were a culturally and ethnically mixed group of 11 women between ages 40 and 60 who met in Manhattan and discussed their lives, feelings, behaviors, and perspectives during this important period. Data analysis led to a three-part developmental model describing women's midlife experiences. Data from this group of participants offered particularly rich descriptions of how they reacted to social stereotypes about midlife.

Association of complementary and alternative medicine use, demographic factors, and perimenopausal symptoms in a multiethnic sample of women: the ENDOW study

Complementary and alternative medicine (CAM) use is common in the United States, particularly among middle-aged women for symptoms commonly reported during perimenopause. The study examined the relationship between women's report of perimenopausal symptoms and the use of CAM and socioeconomic or cultural factors. The prevalence of CAM use was 33%; approximately 94% reported use of CAM therapies and 23% used CAM practitioners. Those who used CAM were younger and better educated; more often they reported pelvic pain and painful intercourse. The only demographic factor to predict use of alternative medicine was education.

The association of endogenous hormone concentrations and bone mineral density measures in pre- and perimenopausal women of four ethnic groups: SWAN

We evaluated bone mineral density (BMD), hormone concentrations and menstrual cycle status to test the hypothesis that greater variations in reproductive hormones and menstrual bleeding patterns in mid-aged women might engender an environment permissive for less bone. We studied 2336 women, aged 42-52 years, from the Study of Women's Health Across the Nation (SWAN) who self-identified as African-American (28.2%), Caucasian (49.9%), Japanese (10.5%) or Chinese (11.4%). Outcome measures were lumbar spine, femoral neck and total hip BMD by dual-energy X-ray densitometry (DXA). Explanatory variables were estradiol, testosterone, sex hormone binding globulin (SHBG) and follicle stimulating hormone (FSH) from serum collected in the early follicular phase of the menstrual cycle or menstrual status [premenopausal (menses in the 3 months prior to study entry without change in regularity) or early perimenopause (menstrual bleeding in the 3 months prior to study entry but some change in the regularity of cycles)]. Total testosterone and estradiol concentrations were indexed to SHBG for the Free Androgen Index (FAI) and the Free Estradiol Index (FEI). Serum logFSH concentrations were inversely correlated with BMD (r = -10 for lumbar spine [95% confidence interval (CI): -0.13, -0.06] and r = -0.08 for femoral neck (95% CI: -0.11, -0.05). Lumbar spine BMD values were approximately 0.5% lower for each successive FSH quartile. There were no significant associations of BMD with serum estradiol, total testosterone, FEI or FAI, respectively, after adjusting for covariates. BMD tended to be lower (p values = 0.009 to 0.06, depending upon the skeletal site) in women classified as perimenopausal versus premenopausal, after adjusting for covariates. Serum FSH but not serum estradiol, testosterone or SHBG were significantly associated with BMD in a multiethnic population of women classified as pre- versus perimenopausal, supporting the hypothesis that alterations in hormone environment are associated with BMD differences prior to the final menstrual period.

Dimensions of sexuality in the perimenopausal transition: a model for practice

A biopsychosocial-cultural model of the sexuality of women during the perimenopausal transition includes dimensions related to physiology, psychosocial issues, and culture. It is an amalgam of biomedical and psychosocial models, yet has the added focus on culture. This holistic approach to sexual health is recommended by researchers and clinicians engaged in the study of midlife women. Clinicians can use this model to guide assessment and interventions, examining all of the dimensions of sexuality during the perimenopausal transition.

The age and symptomatology of natural menopause among United Arab Emirates women

OBJECTIVES

To determine the median age of natural menopause in United Arab Emirates women, the factors affecting that age and the prevalence of climacteric symptoms amongst those women.

METHODS

A population-based survey was conducted on a community sample of United Arab Emirates women who had had natural menopause defined as cessation of menstruation for at least 6 months at the end of reproductive years. A total of 742 women aged 40 years and above were recruited from both urban and rural areas of the country using the multi-stage stratified cluster sampling technique. Data were collected using a structured questionnaire and face to face interviews and included a number of familial, reproductive and life-style variables.

RESULTS

The median age of the menopause in the United Arab Emirates is 48 years (mean = 47.3 +/- 3.29, range 40-59). This is significantly lower than the median age reported from the West (50.3 years). The subject median age of the menopause was significantly related to that of the mother (P < 0.001), older sister (P < 0.001), parity (P < 0.0001) and the previous use of oral contraceptive pills for more than 1 year (P < 0.001). Hot flushes were the commonest feature of the menopause occurring in 45% of women.

CONCLUSION

The age of natural menopause in United Arab Emirates women, as in other developing countries, is less than in Western women and may be influenced by genetic factors, parity and previous use of oral contraceptives. Climacteric symptomatology, however, is similar in the different patient groups.

Menopausal experiences of Thai women. Part 2: The cultural context

This paper describes the cultural context of middle-aged Thai women who took part in a survey of symptoms and attitudes to menopause. The women lived in Nonthaburi province, adjacent to Bangkok, which has undergone a transition from rural to urban. Household structure often includes three generations. There have been changing opportunities for women in areas of education, occupation and family size and women's power increases with age. Thai women perceive menstruation as an indicator of health and take special care during menstruation. There is a special idiom in Thai 'leod cha pai-lom cha ma' (the blood will go--the wind will come) used to describe changes in a woman's behaviour, emotions and well-being during the menopause. These changes are expected to happen occasionally, not in every woman. Some women looked forward to menopause, while others were found to be ambivalent towards it.

Menopausal experiences of Thai women. Part 1: Symptoms and their correlates

This study was a cross-sectional survey of mid-aged Thai women with the following aims: to describe their experience of symptoms and attitudes to menopause and to examine the relationships between symptoms, attitudes to menopause, sociodemographic variables and menopausal status. The sample was 268 women aged between 40 and 59 y who had accompanied patients to the outpatients department of the Royal Irrigation Hospital. Mean age at menopause was 50.13 (SD 4.67) y. Fifty-one percent were premenopausal. 9% perimenopausal and 40% postmenopausal. The symptoms which showed strongest associations (P < 0.001) with menopausal status were: joint aches/pain, hot flushes, depression and insomnia. Women most likely to experience symptoms were: older than 50 years of age, had more children, peri- or post-menopausal, of little education, housewives or landowners and reported their health was not so good and required treatment.

The climacteric among South-American women, who immigrated to Sweden and age-matched Swedish women

Forty-nine immigrated South-American (SA) and 48 Swedish women, aged 42-67 years, were studied in a comparative semi-structured interview survey, concerning the climacteric and its treatment. The mean age at natural menopause was 47 for the South-American women and 50 for the Swedish women. The prevalence of moderate to severe vasomotor symptoms at the time of the survey did not differ significantly between the non-treated, non-operated, postmenopausal South-American and Swedish women (36% and 21%; N.S.). One reason for the trend towards a higher prevalence among South-American women could be that a greater number of Swedish women used hormone replacement treatment compared to South-American women (11 vs. 4). The general attitude to hormone replacement therapy was more positive among South-American women, although they did not use hormone therapy, as could be expected from their symptoms. These results are probably an illustration of the difficulties in getting access to treatment for the immigrated SA women.

Perceptions of menopause in northeast Thailand: contested meaning and practice

This paper draws on data collected from village-based ethnographic research conducted in northeast Thailand in 1990-1991 and highlights the polarities and contradictions of perceptions of menopause that exist between village women and health personnel with whom these women interact. For village women until recently, the menopause has been regarded as a simple and natural biological event; for health professionals, it is consistently represented as a 'medical problem' indicating treatment. The paper highlights women's construction of menopause, and their recognition and management of its physical symptoms. It draws attention too to differences among women and to the dynamic nature of their understandings and consequent health-seeking behaviour. The paper also describes the way in which health providers, through their own training and reading of professional and popular journals, increasingly represent the menopause as a pathological process and treatable condition. Through the exploration of conflicting perceptions of the menopause among contemporary Thai women, the paper draws attention to the heterogeneity and fluidity in understandings of biological processes that are related to and reflect the wider social and economic changes to which they are subject.

The climacteric of Chinese factory workers

Chinese factory workers (427) mainly of Fujian origin were found to have few climacteric symptoms. Of these, 65% and 50% reported having no circulatory and nervosity symptoms, respectively. Only 18% of women experienced hot flushes. The climacteric symptoms were more pronounced at the perimenopausal period (P < 0.001) when these women experienced more irregular menstruation. Low socio-economic status and educational level did not have adverse effects on the symptom reporting. High parity and employment may be positive factors in this period of change of life. A majority of women (74%) felt that the climacteric and menopause is a natural process which caused them no concern. Of those who were still menstruating 80% did not anticipate that they would have problems with the climacteric and menopause. These women's different climacteric pattern could be related to their introspective abilities to cope adequately or in an impersonal manner.

The prevalence of symptoms in menopausal women in the Far East: Singapore segment

Questionnaires (4000) on experience of menopausal symptoms in Singaporean women aged 40-55 were distributed by students. In total, 524 envelopes were returned (13.1%) and of these 420 were analyzed. Of these, 366 were classified as either pre-, peri- or postmenopausal on the basis of their menstrual patterns. Menopausal symptoms in this sample of Singaporean women were, in general, similar to those experienced in the West though the prevalence was low compared to European studies. No significant differences in individual symptoms were found between the 3 groups but, taken together, symptoms were significantly highest in the perimenopausal and lowest in the other menopausal groups. In the postmenopausal group 50% had been menopausal for at least 1 year at 50.5 years.

Climacteric Filipino women: a preliminary survey in the Philippines

In a survey of 500 Filipino women aged 40-50 years, of various professions and residing mostly in Metropolitan Manila, the average age of menopause was estimated at 48 years. The climacteric symptoms were seen to affect 83% of the respondents. Sixty-three percent reported menopause-related circulatory or vasomotor disorders and 79% mentioned psychological disorders. The incidence and frequency of climacteric symptoms were highest among the perimenopausals. Headache was the most common climacteric symptom, while the hot flush was the least prevalent. Only 31% consulted a physician for menopause-related ailments. Eighty-six percent of those who consulted were prescribed medication, however, only 52% of these followed the prescription. Eleven percent reported dyspareunia and only 36% consulted a doctor. Thirty-one percent suffered from urinary stress incontinence and only 16% consulted a doctor. The findings of this study suggest that the average Filipino woman has an attitude of forbearance towards the climacteric syndrome. This attitude is shaped by her Asian culture and Third World circumstances.

Climacteric and menopause in seven South-east Asian countries

The menopause is universal, but what about the climacteric? In an attempt to answer this question, a study was conducted in seven south-east Asian countries, namely, Hong Kong, Indonesia, Korea, Malaysia, the Philippines, Singapore and Taiwan. Samples of approximately 400 women in each country were questioned about a number of climacteric complaints, incontinence and dyspareunia, consultation of a physician, menopausal status and several background characteristics. Special care was taken to overcome linguistic and cultural problems, and the data collected were kept as objective as possible. From the results obtained we were able to show that the climacteric was indeed experienced in south-east Asian countries, although in a mild form. The prevalence of hot flushes and of sweating was lower than in western countries, but was nevertheless not negligible. The percentages of women who reported the more psychological types of complaint were similar to those in western countries. The occurrence of climacteric complaints affected perceived health status. A physician was consulted for climacteric complaints by 20% of the respondents, although this was most frequently associated with the occurrence of psychological complaints and less so with that of hot flushes and sweating. The median age at menopause (51.09) appeared to be within the ranges observed in western countries. Ethnic background and age at menarche were found to have a significant influence on age at menopause. The study clearly demonstrated that climacteric complaints occur in south-east Asia. The findings suggest, however, that vasomotor-complaint-related distress might be 'translated' into psychological complaints, which are more frequently considered to warrant consulting a physician.

A study on the menopause in Malaysia

In an attempt to gather data on the menopause in Malaysia, 400 women (13% Chinese, 70% Malays and 16% Indians), representing the three major ethnic groups in Malaysia, were interviewed. The majority (76%) of these women were still married and living with their husbands and 63% of them were working. Most of them (90%) had attained menarche by the age of 15 years and 50% of them had married before the age of 20. Their reproductive record was good, since 76% of them had 3 or more children who were still alive. The mean age at menopause in the Malaysian women studied was 50.7 years. Analysis of the climacteric symptoms reported showed significant differences in the vasomotor and nervosity indices in the perimenopausal and postmenopausal groups. Eighty percent (80%) of the women saw no need to consult a doctor about their climacteric symptoms. When they did, most of them (84%) received medication, but 43% of them did not comply with the prescribed treatment. Dyspareunia and urinary incontinence were evidently regarded as embarrassing complaints in all three groups, since around 80% of the women did not seek medical advice. This is not surprising in view of the fact that 89% of them rated their health as good.

The menopausal age and climacteric complaints in Thai women in Bangkok

Age at menopause, associated factors and related clinical symptoms were recorded in a sample of Thai women living in the Bangkok area. Interviews by trained nurses were offered to a sample of 2375 women aged 45-59 years selected at random in 19 of the 54 Bangkok Metropolis Administration health centers. Full reports were obtained from 2354 women. Fifty-six percent of the study population were classified as postmenopausal, i.e. having no vaginal bleeding during the last 12 months, 12% were perimenopausal, i.e. having irregular vaginal bleeding during the last 12 months and 31% were premenopausal, i.e. having regular vaginal bleeding during the last 12 months. The average age at menopause was 49.5 +/- 3.6 years and was not related to body weight, height, age at menarche, level of education, smoking or use of oral contraceptives. However, high parity was significantly correlated to delayed menopause. Clinical symptoms of oestrogen deficiency were reported at a significantly higher rate in the perimenopause group, but the premenopause and postmenopause groups did not differ in their complaints about any symptom, including hot flushes. The most striking effect of menopause was a dramatic loss of sexual desire in 86.9% of postmenopausal women. However, the situation did not induce any specific complaint or any request for medical support.

Menopausal age of Ghanaian women

OBJECTIVE

The purpose of the study was to determine the age of menopause among Ghanaian women.

METHOD

A prospective survey involving 152 women in Akosombo District in Ghana was conducted. A questionnaire was developed including: age at menopause, symptoms of hot flushes or flashes, palpitations, anxiety, sleeplessness, headaches, frequency of urine, depression, irritability, tiredness, weight gain, poor memory and attitudes to coitus.

RESULT

Of 152 women interviewed, 29 were excluded because they were not sure of their birth dates and 123 women were analyzed. The mean and median ages at menopause were 48.05 years +/- 3.62 S.D. and 48 years respectively. The major symptoms at menopause were tiredness 79.9%, sleeplessness 71.0%, palpitations 63.7%, weight gain 61.8%, hot flushes 56.5%, and irritability 56.5%. However, 85.6% of the women who experienced hot flushes reported this to be the most unpleasant.

CONCLUSION

1. The age at menopause in Ghanaian population was 48.05 +/- 3.62. 2. Tiredness, sleeplessness, palpitations, weight gain, hot flushes, irritability, anxiety and headache were the major symptoms at menopause. 3. Hot flushes or flashes was the most disturbing symptom at menopause.

Characteristics of menopause in three socioeconomic urban groups in Karachi, Pakistan

To determine age, symptoms and treatment choices in Pakistani women with spontaneous menopause, three groups in Karachi were interviewed using a structured questionnaire. The groups consisted of 250 poor slum dwellers, 250 middle class clinic attenders and 150 wives of retired military officers. Interviews were carried out in 1989 and 1990 by members of a team from the Aga Khan University consisting of a gynaecologist, a community health physician and two senior medical students. All interviewees had natural menopause at least 12 months previously. The results showed a mean age of 47 years for menopause in all groups. One in five women were symptomatic in the poorest group but one in two were in the other groups. Treatment was sought by 6% in the poor group, 26% of the middle class group and 38% of the most privileged group. Age at menopause was 4 years earlier than in most reports and fewer women had menopausal symptoms. These urban women may not represent the situation across the country but, as life expectancy in Pakistan is rising (now 56.4 years for women), menopausal problems may increase.

Menopausal symptoms among Thai women in Bangkok

A random probability cluster area sampling of 614 women living in Bangkok was conducted to determine the prevalence of abnormal symptoms related to the menopause. Women interviewed were aged 40 and above currently registered as living in the Bangkok Metropolitan area. Sixty-nine percent of the women interviewed experienced abnormal symptoms. Eighty-two percent of those with abnormal symptoms reported having hot flushes. Palpitation, increased heat intolerance and emotional liability were common symptoms. Minor abnormalities included insomnia, weakness, anxiety and urinary symptoms. Changes related to sexual function were difficult to elicit due to cultural limitations. Economic and cultural factors might play important roles in the way these women perceived symptoms related to the menopause and sought medical assistance.

Climacteric symptoms in a Tanzanian community

Climacteric symptoms were investigated among healthy women living in and around a small town in Tanzania. The incidence of symptoms was high and similar to that recorded in Western societies. Statistically significant associations were observed between some symptoms and the number of years since menopause. More attention needs to be paid to climacteric problems among African women.

How age conditions the relationship between climacteric status and health symptoms in African American women

The purpose of this investigation was to evaluate the relationship between climacteric status and health symptoms across age cohorts in 522 African American women aged 25-75. Data were collected through home interviews and subjected to hierarchical regression analyses. In the overall sample a direct relationship was found between climacteric status and physical health symptoms but not mental health symptoms. A direct relationship between climacteric status and both physical and mental health symptoms was found for the younger age cohort 25-34. There was a direct relationship between climacteric status and physical health symptoms but not mental health symptoms for the 35-44 age cohort. The relationship between climacteric status and physical and mental health symptoms held despite controls for education, income, marital status, and body mass.

Clinical, hormonal and biochemical features of menopausal women in Ibadan, Nigeria

As a result of the general lack of information about the menopause in Nigeria this study was conducted to determine the prevalence of climacteric symptoms in a cohort of healthy perimenopausal women and also to evaluate the hormonal and biochemical profile of the subjects. Seventeen menopausal and 19 premenopausal women aged 40 years or more were interviewed and had venepuncture and collection of 24-h urine samples. Plasma from the blood samples was used for the assay of LH, FSH, progesterone, 17 beta-oestradiol, calcium and cholesterol while urinary calcium was determined from the 24-h urine samples. The data revealed a significant difference in the prevalence of the symptoms of vasomotor instability (hot flushes, palpitations and excessive sweating) among the menopausal group when compared with the premenopausal group. Furthermore, plasma gonadotrophin levels (LH and FSH) were significantly elevated while plasma oestradiol and progesterone levels were lower in the menopausal women than in the premenopausal group. With regards to the biochemical indices evaluated, only 24-h urinary calcium levels were found to be significantly different for the two groups, with higher levels in the menopausal women. The significance of these findings and the need for adequate screening and treatment of selected menopausal women are discussed.

Cultural construction of the menopausal syndrome: the Japanese case

Europe and North America have been the focus of most research on the menopause and its symptoms. In this study, in the course of in-depth interviews Japanese physicians and women were asked to describe the menopausal experience. A cross-sectional survey concerning women and their health at midlife was then distributed to 1738 women. The analysis in this paper is based on the replies received from 1141 non-hysterectomized women aged 45-55. Factor analysis was used to group the symptoms these women had experienced in the previous 2 wk. After constructing an index based on the factor scores, one-way analysis of variance was used to examine the relationship between symptom experience and the epidemiological menopausal status as well as the self-defined menopausal status. Symptom experience was always significantly related to self-defined menopausal status.